Browsing by Author "Ha, Yoon"

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    Coronal plane spinal malalignment and Parkinson's disease: prevalence and associations with disease severity.
    (The spine journal : official journal of the North American Spine Society, 2015-01) Choi, Hong June; Smith, Justin S; Shaffrey, Christopher I; Lafage, Virginie C; Schwab, Frank J; Ames, Christopher P; Matsumoto, Morio; Baik, Jong Sam; Ha, Yoon

    Background context

    Parkinson's disease (PD) is a progressive degenerative disorder of the central nervous system. Patients with PD often present with abnormal posturing.

    Purpose

    To investigate coronal plane deformities in patients with PD, and to evaluate the correlation between clinical features, coronal parameters related to spine alignment, and disease severity.

    Study design

    A cross-sectional study.

    Patient sample

    Eighty-nine patients with PD and 89 controls were included.

    Outcome measures

    A medical history was collected from the medical records.

    Methods

    This study was a prospective assessment of consecutive patients with PD. Clinical and demographic parameters were collected from medical records and outpatient interviews. Full-length standing anteroposterior and lateral spine radiographs were used to assess the spinal parameters. The threshold for scoliosis was set at a 10° Cobb angle, and the curve type was classified using Schwab classification.

    Results

    A total of 178 patients (89 in PD and 89 in control groups) were included. Scoliosis was identified in 27 patients (30%) and 22 controls (p=.502). However, coronal imbalance was more common in patients with PD than in controls (11 vs. 0 patients, p=.001). Scoliosis was more common in women than in men (male:female=8:19, p=.04). Back pain was more common in patients with scoliosis than in those without scoliosis (14 of 27 vs. 17 of 62, p=.036). Schwab Type IV (thoracolumbar major) was the most common type of scoliosis in patients with PD and Type V (lumbar major) was the most common type in controls. With adjustment for patient age and gender, multiple linear regression analysis revealed that severity of PD (Unified Parkinson's Disease Rating Scale, p=.037) and magnitude of global coronal malalignment (p=.003) were associated with the scoliosis Cobb angle (p=.037, B=0.139). Direction of scoliosis and side of global coronal malalignment were not significantly correlated with the laterality of predominant PD symptoms (p>.05).

    Conclusions

    Global coronal malalignment is more prevalent in patients with PD than in controls. Greater severity of PD was significantly associated with greater magnitude of scoliosis Cobb angle, even after adjusting for the effects of patient age and gender. However, direction of scoliosis and side of global coronal malalignment were not significantly associated with the dominant laterality of PD symptoms.
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    Diversity in Surgical Decision Strategies for Adult Spine Deformity Treatment: The Effects of Neurosurgery or Orthopedic Training Background and Surgical Experience.
    (Neurospine, 2018-08-29) Kang, Jiin; Hosogane, Naobumi; Ames, Christopher; Schwab, Frank; Hart, Robert; Burton, Douglas; Shaffrey, Christopher; Smith, Justin S; Bess, Shay; Lafage, Virginie; Cho, Kyu-Jung; Ha, Yoon
    This study is aimed to investigate whether surgical strategies for adult spinal deformity (ASD) treatment differed among Korean physicians.This study is retrospective questionnaire-based study. ASD is challenging to manage, with a broad range of clinical and radiological presentations. To investigate possible nationality- or ethnicity-related differences in the surgical strategies adopted for ASD treatment, the International Spine Study Group surveyed physicians' responses to 16 cases of ASD. We reviewed the answers to this survey from Korean physicians. Korean orthopedic surgeons (OS) and neurosurgeons (NS) received a questionnaire containing 16 cases and response forms via email. After reviewing the cases, physicians were asked to indicate whether they would treat each case with decompression or fusion. If fusion was chosen, physicians were also asked to indicate whether they would perform 3-column osteotomy. Retrospective chi-square analyses were performed to investigate whether the answers to each question differed according to training specialty or amount of surgical experience.Twenty-nine physicians responded to our survey, of whom 12 were OS and 17 were NS. In addition, 18 (62.1%) had more than 10 years of experience in ASD correction and were assigned to the M10 group, while 11 (37.9%) had less than 10 years of experience and were assigned to the L10 group. We found that for all cases, the surgical strategies favored did not significantly differ between OS and NS or between the M10 and L10 groups. However, for both fusion surgery and 3-column osteotomy, opinions were divided regarding the necessity of the procedures in 4 of the 16 cases.The surgical strategies favored by physicians were similar for most cases regardless of their training specialty or experience. This suggests that these factors do not affect the surgical strategies selected for ASD treatment, with patient clinical and radiological characteristics having greater importance.
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    Impact of Movement Disorders on Management of Spinal Deformity in the Elderly.
    (Neurosurgery, 2015-10) Ha, Yoon; Oh, Jae Keun; Smith, Justin S; Ailon, Tamir; Fehlings, Michael G; Shaffrey, Christopher I; Ames, Christopher P
    Spinal deformities are frequent and disabling complications of movement disorders such as Parkinson disease and multiple system atrophy. The most distinct spinal deformities include camptocormia, antecollis, Pisa syndrome, and scoliosis. Spinal surgery has become lower risk and more efficacious for complex spinal deformities, and thus more appealing to patients, particularly those for whom conservative treatment is inappropriate or ineffective. Recent innovations and advances in spinal surgery have revolutionized the management of spinal deformities in elderly patients. However, spinal deformity surgeries in patients with Parkinson disease remain challenging. High rates of mechanical complications can necessitate revision surgery. The success of spinal surgery in patients with Parkinson disease depends on an interdisciplinary approach, including both surgeons and movement disorder specialists, to select appropriate surgical patients and manage postoperative movement in order to decrease mechanical failures. Achieving appropriate correction of sagittal alignment with strong biomechanical instrumentation and bone fusion is the key determinant of satisfactory results.
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    Introduction. Adult spinal deformity.
    (Neurosurgical focus, 2017-12) Shaffrey, Christopher I; Smith, Justin S; Ames, Christopher P; Yagi, Mitsuru; Alanay, Ahmet; Ha, Yoon
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    Prevalence and type of cervical deformities among adults with Parkinson's disease: a cross-sectional study.
    (Journal of neurosurgery. Spine, 2016-04) Moon, Bong Ju; Smith, Justin S; Ames, Christopher P; Shaffrey, Christopher I; Lafage, Virginie; Schwab, Frank; Matsumoto, Morio; Baik, Jong Sam; Ha, Yoon

    Object

    To identify the characteristics of cervical deformities in Parkinson's disease (PD) and the role of severity of PD in the development of cervical spine deformities, the authors investigated the prevalence of the cervical deformities, cervical kyphosis (CK), and cervical positive sagittal malalignment (CPSM) in patients with PD. They also analyzed the association of severity of cervical deformities with the stage of PD in the context of global sagittal spinopelvic alignment.

    Methods

    This study was a prospective assessment of consecutively treated patients (n = 89) with PD. A control group of the age- and sex-matched patients was selected from patients with degenerative cervical spine disease but without PD. Clinical and demographic parameters including age, sex, duration of PD, and Hoehn and Yahr (H&Y) stage were collected. Full-length standing radiographs were used to assess spinopelvic parameters. CK was defined as a C2-7 Cobb angle < 0°. CPSM was defined as C2-7 sagittal vertical axis (SVA) > 4 cm.

    Results

    A significantly higher prevalence of CPSM (28% vs. 1.1%, p < 0.001), but not CK (12% vs. 10.1%, p = 0.635), was found in PD patients compared with control patients. Among patients with PD, those with CK were younger (62.1 vs. 69.0 years, p = 0.013) and had longer duration of PD (56.4 vs. 36.2 months, p = 0.034), but the severity of PD was not significantly different. Logistic regression analysis revealed that the presence of CK was associated with younger age, higher mismatch between pelvic incidence and lumbar lordosis, and lower C7-S1 SVA. The patients with CPSM had significantly greater thoracic kyphosis (TK) (p < 0.001) and a trend toward more advanced H&Y stage (p = 0.05). Logistic regression analysis revealed that CPSM was associated with male sex, greater TK, and more advanced H&Y stage.

    Conclusions

    Patients with PD have a significantly higher prevalence of CPSM compared with age- and sex-matched control patients with cervical degenerative disease but without PD. Among patients with PD, CK is not associated with the severity of PD but is associated with overall global sagittal malalignment. In contrast, the presence of CPSM is associated more with the severity of PD than it is with the presence of global sagittal malalignment. Collectively, these data suggest that the neuromuscular pathogenesis of PD may affect the development of CPSM more than of CK.
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    Prevention of Surgical Site Infections in Spine Surgery: An International Survey of Clinical Practices Among Expert Spine Surgeons.
    (Global spine journal, 2022-02) Tkatschenko, Dimitri; Hansen, Sonja; Koch, Julia; Ames, Christopher; Fehlings, Michael G; Berven, Sigurd; Sekhon, Lali; Shaffrey, Christopher; Smith, Justin S; Hart, Robert; Kim, Han Jo; Wang, Jeffrey; Ha, Yoon; Kwan, Kenny; Hai, Yong; Valacco, Marcelo; Falavigna, Asdrubal; Taboada, Néstor; Guiroy, Alfredo; Emmerich, Juan; Meyer, Bernhard; Kandziora, Frank; Thomé, Claudius; Loibl, Markus; Peul, Wilco; Gasbarrini, Alessandro; Obeid, Ibrahim; Gehrchen, Martin; Trampuz, Andrej; Vajkoczy, Peter; Onken, Julia

    Study design

    Questionnaire-based survey.

    Objectives

    Surgical site infection (SSI) is a common complication in spine surgery but universal guidelines for SSI prevention are lacking. The objectives of this study are to depict a global status quo on implemented prevention strategies in spine surgery, common themes of practice and determine key areas for future research.

    Methods

    An 80-item survey was distributed among spine surgeons worldwide via email. The questionnaire was designed and approved by an International Consensus Group on spine SSI. Consensus was defined as more than 60% of participants agreeing to a specific prevention strategy.

    Results

    Four hundred seventy-two surgeons participated in the survey. Screening for Staphylococcus aureus (SA) is not common, whereas preoperative decolonization is performed in almost half of all hospitals. Body mass index (BMI) was not important for surgery planning. In contrast, elevated HbA1c level and hypoalbuminemia were often considered as reasons to postpone surgery. Cefazoline is the common drug for antimicrobial prophylaxis. Alcohol-based chlorhexidine is mainly used for skin disinfection. Double-gloving, wound irrigation, and tissue-conserving surgical techniques are routine in the operating room (OR). Local antibiotic administration is not common. Wound closure techniques and postoperative wound dressing routines vary greatly between the participating institutions.

    Conclusions

    With this study we provide an international overview on the heterogeneity of SSI prevention strategies in spine surgery. We demonstrated a large heterogeneity for pre-, peri- and postoperative measures to prevent SSI. Our data illustrated the need for developing universal guidelines and for testing areas of controversy in prospective clinical trials.
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    Reciprocal changes in cervical spine alignment after corrective thoracolumbar deformity surgery.
    (European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2014-03) Ha, Yoon; Schwab, Frank; Lafage, Virginie; Mundis, Gregory; Shaffrey, Christopher; Smith, Justin; Bess, Shay; Ames, Christopher

    Purpose

    To identify changes in cervical alignment parameters following surgical correction of thoracolumbar deformity and then assess the preoperative parameters which induce changes in cervical alignment following corrective thoracolumbar deformity surgery.

    Methods

    A retrospective study of 49 patients treated for thoracolumbar deformity with preoperative planning of an acceptably aligned coronal and sagittal plane in each case. We compared cervical spine parameters in two distinct low [preoperative C7 sagittal vertical axis (SVA) ≤ 6 cm] and high (preoperative C7 SVA ≥ 9 cm) C7 SVA groups. Multilinear regression analysis was performed and revealed the relationship between postoperative cervical lordosis and preoperative spinopelvic parameters and surgical plans.

    Results

    In the lower C7 SVA group, cervical lordosis was significantly increased after thoracic/lumbar deformity correction (p < 0.01). In contrast, the high C7 SVA group showed decreased cervical lordosis postoperatively (p < 0.01). Multilinear regression analysis demonstrated the preoperative parameters (preoperative C2-7 angle, T1 slope, surgical plan for PT and C7 SVA), which determine the postoperative cervical lordosis.

    Conclusion

    In spinal deformity procedures, preoperative spinal alignment parameters, and surgical plans could affect postoperative cervical spine alignment.
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    Sagittal spinopelvic malalignment in Parkinson disease: prevalence and associations with disease severity.
    (Spine, 2014-06) Oh, Jae Keun; Smith, Justin S; Shaffrey, Christopher I; Lafage, Virginie; Schwab, Frank; Ames, Christopher P; Matsumoto, Morio; Baik, Jong Sam; Ha, Yoon

    Study design

    Prospective study.

    Objective

    Our objectives were to evaluate the prevalence of sagittal spinopelvic malalignment in a consecutive series of patients with Parkinson disease (PD) and to identify factors associated with sagittal spinopelvic deformity in this population.

    Summary of background data

    PD is a degenerative neurological condition characterized by tremor, rigidity, bradykinesia, and loss of postural reflexes. The prevalence of spinal deformity in PD is higher than that of age-matched adults without PD.

    Methods

    This study was a prospective assessment of consecutive patients with PD presenting to a neurology clinic during 12 months. Inclusion criteria included age more than 21 years and diagnosis of PD. Age- and sex-matched control group was selected from patients with cervical spondylosis. Clinical and demographic factors were collected including Unified Parkinson Disease Rating Scale score and Hoehn and Yahr stage. Full-length standing spine radiographs were assessed. Patients were grouped into either low C7 sagittal vertical axis (SVA) (<5 cm) or high C7 SVA (≥5 cm) and into matched (≤10°) or mismatched (>10°) pelvic incidence (PI)-lumbar lordosis.

    Results

    Eighty-nine patients met criteria (41 males/48 females), including 52 with low C7 SVA and 37 with high C7 SVA. Significantly higher prevalence of high C7 SVA was found in PD (41.6 vs. 16.8%; P < 0.001). The high C7 SVA group was significantly older (72.4 vs. 65.1 yr; P < 0.001) and had a higher proportion of females (68% vs. 44%; P = 0.034), greater severity of PD based on Hoehn and Yahr stage (1.89 vs. 1.37; P < 0.001) and Unified Parkinson Disease Rating Scale (30.5 vs. 17.2; P = 0.002. Unified Parkinson Disease Rating Scale significantly correlated with C7 SVA (r = 0.474). Compared with the matched (≤10°) PI-lumbar lordosis group, the mismatch PI-lumbar lordosis group had higher C7 SVA, higher PI, higher pelvic tilt, lower lumbar lordosis, and lower thoracic kyphosis (P ≤ 0.003).

    Conclusion

    Patients with PD have a high prevalence of sagittal spinopelvic malalignment than control group patients. Greater severity of PD is associated with sagittal spinopelvic malalignment.

    Level of evidence

    3.